Is Football to Blame for Players' Suicides?

High-profile suicides of professional football players have mounted in the past several years—Terry Long (2005), Andre Waters (2006), Dave Duerson (2011) and Ray Easterling (2012) all killed themselves following retirement and bouts with diagnoses likely related to the thousands of hits they fearlessly underwent as players. The conditions vary but have overlapping qualities: post-concussion syndrome, depression, other mood disorders, personality changes, memory problems and dementia. Now with the loss of Pro Bowler Junior Seau, dead at 43 earlier this month by a self-inflicted gunshot wound to his chest, a suicide has occurred in a Hall of Fame-bound player who reportedly never exhibited emotional pain. His body will be examined for signs of chronic traumatic encephalopathy (CTE), a condition proposed to explain the football suicides and underlying mental illness.

The issue of professional football's responsibility for these conditions and player suicides is explored in Headstrong, a play running this month at the Ensemble Studio Theater in Manhattan. The theater has a long-standing sponsorship from the Alfred P. Sloan Foundation to produce shows that deal with science. (Last year with this funding, EST mounted Photograph 51, which explored the role of Rosalind Franklin in the discovery of the structure of DNA.)

In the past few years, the terms "brain injury" and "traumatic brain injury" have replaced the all-encompassing but limited categorization of "concussion." Examinations by pathologist Bennet Omalu, now at the University of California, Davis, have led to a connection between high-impact sports and CTE, a condition diagnosed after death and marked by degenerated brain tissue and an accumulation of tau proteins in the brain. Injuries may result from rapid deceleration whether that involves a blow to the head or not.

One of the main social questions emerging in the past few years is whether the National Football League is doing enough to protect players from brain injuries and the mental illnesses and cognitive problems that can follow. Scientifically, it is still unclear if CTE itself explains players' declining mental health and suicides.

The league has responded so far with a ban on helmet-to-helmet hits, educational campaigns and new rules governing when a concussed player may return to the field. And the NFL has initiated scientific investigations into brain injuries—although questions of bias will plague any league-sponsored research. The league might be seen as having an incentive to minimize concerns about traumatic brain injuries.

All these issues come up in Headstrong. The play dives straight into this tangle of causality and ethics, focusing on the family aftermath two weeks after fictional NFL running back Ronnie Green kills himself at age 35 by drinking antifreeze (a "coward's way out," his ex-NFL father-in-law Duncan Troy calls it). His character had suffered from erratic behavior and depression prior to his death. (The story line is similar to the real-life case of Steelers lineman Terry Long who drank antifreeze to end his life at age 45 in 2005 following problems with depression.) Green's estranged wife Sylvia is asked to donate her husband's brain to science to look for signs of CTE, but the choice pushes her smack up against the bullet-proof, tough-guy, play-hurt culture that is sacred to football and her father.

As Sylvia notes near the end of Headstrong, football often pays players handsomely for their careers (the average NFL career lasts somewhere between 3.5 and 6 years). It pays for players' homes and their children's college tuition, clothes and so on. "Now we have to pay for football," she notes with bitterness, referring to the death of her estranged husband and more, adding that she has decided that her son will not play football. ("Why don't you just stab me in the heart?" her father responds.)

The paternal Duncan Troy represents classic, suck-it-up, all-or-nothing football—if you admit or indulge any weakness in players or the game, you ruin football. "Hitting is part of the game," he says. "Take hitting away and you have checkers."

Back in real life, Omalu now has permission to study Seau's brain, but is it hard to imagine that the pathologist will fail to find evidence of brain injury. That assumed finding raises a question about the robustness of the link to suicide: how many players who have not shown evidence of degenerative brain conditions might also show signs of brain trauma related to repeated hits? Until such studies are done, the connection between hits and the most negative outcomes will remain a subject of debate. [Click here to listen to a Science Talk podcast featuring a post-performance panel discussion of these issues on May 12 with Omalu, Hall of Famer Harry Carson (center in photo), who suffers from post-concussion syndrome, and NBC journalist Stone Phillips (at left in photo).]

Meanwhile, reports such as The Concussion Crisis: Anatomy of a Silent Epidemic (Simon & Schuster, 2011) and others make it clear that the NFL and other bodies have balked for years at looking squarely at the issue of sport-caused brain injuries and embracing efforts to protect players. And many other researchers are now finding strong links between traumatic brain injuries and mental decline among athletes of all ages (the hits to young people might do the most damage, especially those that occur back-to-back) as well as among servicemen and women afflicted by ordnance blasts.

Would future insights that might nail down the role of CTE in players' mental health reduce "America's game" to a bland ballet? The nation's love of football and the powerful football industry are bigger than these fears just as it was bigger than the steroid panic of several years ago.

But who can look at the retirement years of many professional football players and say that everything possible is being done for them, that they were made aware of all the risks? As David Epstein notes in his "Depression in Football" story in the May 14 issue of Sports Illustrated, brain trauma experts he interviewed hope next for renewed research efforts to track players and their various medical issues, including depression and concussions, in order to tease out the connections among them.

At the least, the NFL, NCAA and other governing bodies should be held to the task of providing care for these remarkable athletes throughout their lives, not just during the halcyon years when they sacrifice their long-term health, physical and mental, to dazzle us on field.

"A win is a win," Duncan Troy says in Headstrong. "That's the only thing that matters."

He's wrong.

Image credits: Gerry Goodstein, Ensemble Studio Theatre; Steve Mirsky

The views expressed are those of the author and are not necessarily those of Scientific American.

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